Static outliers for Griffiths Drive Medical Practice

There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain. At OpenPrescribing we are piloting a number of data-driven approaches to identify unusual prescribing and collect feedback on this prescribing to inform development of new tools to support prescribers and organisations to audit and review prescribing.

This report has been developed to automatically identify prescribing patterns at a chemical level which are furthest away from “typical prescribing” and can be classified as an “outlier”. We calculate the number of prescriptions for each chemical in the BNF coding system using the BNF subparagraph as a denominator, for prescriptions dispensed between April 2021 and August 2021. We then calculate the mean and standard deviation for each numerator and denominator pair across all practices/CCGs/PCNs/STPs. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given practice/CCG/PCN/STP is from the population mean. We then rank your “z-scores” to find the top 5 results where prescribing is an outlier for prescribing higher than its peers and those where it is an outlier for prescribing lower than its peers.

It is important to remember that this information was generated automatically and it is therefore likely that some of the behaviour is warranted. This report seeks only to collect information about where this variation may be warranted and where it might not. Our full analytical method code is openly available on GitHub here.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at ebmdatalab@phc.ox.ac.uk. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

Prescribing where Griffiths Drive Medical Practice is higher than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Nevirapine☰	1	HIV infection	1	1.00	0.00	0.05	18.19
Nevirapine 200mg tablets : 1
Budesonide☰	69	Drugs used in nasal allergy	300	0.23	0.01	0.02	11.57
Budesonide 64micrograms/dose nasal spray : 67 Rhinocort Aqua 64 nasal spray : 2
Valsartan☰	55	Angiotensin-II receptor antagonists	358	0.15	0.02	0.02	7.03
Valsartan 160mg capsules : 50 Valsartan 80mg capsules : 2 Valsartan 40mg capsules : 3
Estradiol valerate☰	22	Oestrogens and Hormone Replacement Therapy	80	0.28	0.03	0.04	6.05
Progynova 1mg tablets : 1 Estradiol valerate 2mg tablets : 21
Moxifloxacin☰	1	Quinolones	5	0.20	0.01	0.03	5.83
Moxifloxacin 400mg tablets : 1

Prescribing where Griffiths Drive Medical Practice is lower than most

BNF Chemical	Chemical Items	BNF Subparagraph	Subparagraph Items	Ratio	Mean	std	Z_Score	Plots
Gliclazide☰	74	Sulfonylureas	122	0.61	0.92	0.14	-2.35
Gliclazide 80mg tablets : 41 Gliclazide 40mg tablets : 26 Gliclazide 30mg modified-release tablets : 7
Tamoxifen citrate☰	0	Breast cancer	35	0.00	0.27	0.14	-1.97
Pizotifen malate☰	8	Prophylaxis of migraine	58	0.14	0.65	0.26	-1.96
Pizotifen 1.5mg tablets : 3 Pizotifen 500microgram tablets : 5
Estradiol☰	15	Oestrogens and Hormone Replacement Therapy	80	0.19	0.46	0.14	-1.93
Estradiol 25micrograms/24hours transdermal patches : 2 Estradiol 50micrograms/24hours transdermal patches : 2 Estradot 100micrograms/24hours patches : 2 Zumenon 1mg tablets : 1 Evorel 25 patches : 1 Elleste Solo 1mg tablets : 1 Estradiol 0.06% gel (750microgram per actuation) : 3 Evorel 50 patches : 3
Moxonidine☰	0	Centrally-acting antihypertensive drugs	5	0.00	0.64	0.34	-1.92